Dr. Christi Patton
Appearances
Health Chatter
Tobacco Cessation
So cigars, pipes, cigarettes, And so how we measure their use is if you think about anyone that has a carbon monoxide detector with smoking, when we're trying to measure if someone has quit smoking, we use a little device that measures the breath carbon monoxide or the person's exposure to carbon monoxide. And it only measures recent use. So say over the,
Health Chatter
Tobacco Cessation
at the most over the past day, usually within the past four hours. So those readings can be pretty high in an established user of these burned tobacco products. So we always hear about carbon monoxide, right? So if someone's leaving on a stove or burning things in their home, that is a health hazard. So this is someone who's inhaling those that burned, that carbon monoxide is present
Health Chatter
Tobacco Cessation
And if we think about a daily cigarette smoker and the potential health effects related to that. Cigarettes also have various other chemicals and same with pipes and cigars. So with the e-cigarettes, nicotine pouches, those contain nicotine, but not the tobacco leaves. So an e-cigarette is heated and the liquid becomes an aerosol that's inhaled or vaped into the lungs.
Health Chatter
Tobacco Cessation
So that can cause irritation in the lungs, but it's not that burned product. So, you know, that's why these products are kind of thought to be safer to use. But as I said, you know, other than irritation, mouth irritation, lung irritation, coughing, headache, some people report with e-cigarettes. We know very little about the longer term effects like we do with these burn products.
Health Chatter
Tobacco Cessation
So Dr. Patton, you talked about tobacco burn and you kind of mentioned some of the chemicals. Could you tell us what chemicals are inhaled or present when people do like a tobacco? I mean, I think people just say, well, I'm just smoking tobacco leaf. But there's some other things that are also being released at that same time. Am I correct?
Health Chatter
Tobacco Cessation
Yeah, I think there's Hundreds of chemicals, I want to say, added to cigarettes. It's amazing. Even arsenic. Just, you know, small amounts of these different chemicals. But it's like with anything with your health, if you're or if you think about food that you eat, if someone told you hundreds of additional chemicals were added to that food, that would be difficult to think about.
Health Chatter
Tobacco Cessation
Yes. Researchers have looked at assessing or measuring social norms and those, those definitely have changed. There is more awareness. So if I, so I mentioned in Alaska, I have been focusing on youth and pregnant women and I, I don't know about all of you, but I think it's rare to see, you know, in Minnesota or kind of the lower 48 States, uh, pregnant women smoking nowadays.
Health Chatter
Tobacco Cessation
Whereas before, um, apparently in the fifties, that was pretty common. My mom talked about smoking, you know, with me and, um, I have five siblings, so same with them. So, um, but, so I think it's rare nowadays to see that maybe in some States where it's more acceptable. So I, I, And that is due to kind of that more awareness of the health effects and also stigma.
Health Chatter
Tobacco Cessation
Thank you, Stan, for passing it off to me. We have Dr. Christy Patton. She is a licensed clinical psychologist. She's a professor of psychology and director of the Behavioral Health Research Program and the Rural Health Core at Mayo Clinic in Rochester, Minnesota. She grew up in Minneapolis and completed her undergraduate degree in psychology at Augsburg College.
Health Chatter
Tobacco Cessation
So along with the social norms changing, more awareness, there does come stigma, which does make it hard for people to seek treatment.
Health Chatter
Tobacco Cessation
But in Alaska, you know, pregnant women are smoking and using tobacco and It's not that there's a lack of awareness, it's more the acceptability, more the favorable social norms.
Health Chatter
Tobacco Cessation
So that's kind of an example I think about where there have been changes in social norms, but like I said, in certain communities where there may be different social norms or the tobacco industry may be aggressively targeting certain communities.
Health Chatter
Tobacco Cessation
Her research team focuses on community-based participatory research to develop culturally aligned behavioral intervention for smoking cessation and other health promotion interventions among indigenous people and other communities. She is in partnership with Michelle Allen and Rachel Hardiman at the University of Minnesota.
Health Chatter
Tobacco Cessation
Just following up on that with the effective behavioral programs for youth, and just delivering those programs myself to youth, the long-term consequences really don't resonate. It's more those short-term impacts that youth are experiencing. So appearance-related effects, so yellow stained teeth, breathing difficulties, like with their sports. So what you were saying, Dr. Baines, really resonated.
Health Chatter
Tobacco Cessation
And yes, those public health Policy initiatives are super effective with taxes, raising the minimum age for selling tobacco products. And then public health camp, mass media campaigns are extremely effective. So there's things that we can do on a policy public health level that are extremely effective.
Health Chatter
Tobacco Cessation
Yeah, I would expect that would be an upcoming major issue with the legalization. That really introduces a lot of room for potential uptake of use and or continuation of use, likely in combination with tobacco use.
Health Chatter
Tobacco Cessation
Dr. Patton co-leads a large grant from the NIH called C to Dream Center for Chronic Disease Reduction and Equity Promotion across Minnesota. Dr. Patton also served as recent co-chair of the Health Experiences Network for the Society of Research on Nicotine and Tobacco and has held many other leadership roles nationally.
Health Chatter
Tobacco Cessation
Yeah, so tobacco use continues to remain high among individuals experiencing mental health issues, so depression, anxiety. Pretty strikingly, differences in prevalence for people with depression versus people if they're not reporting depression, for example. And so people in practice talk quite a bit about more along the lines of stress.
Health Chatter
Tobacco Cessation
We might give them a questionnaire and find out they're scoring high on depression, but when people are just talking about the smoking, they talk about stress and more that it's hard to quit because of the stress that they're experiencing in their lives. A lot of my research has focused on people with depression, psychiatric disorders, and smoking cessation.
Health Chatter
Tobacco Cessation
So, for example, we had a program with women who were experiencing moderate to severe depression, and we looked at an exercise program for smoking cessation because we know from research that exercise is helpful in reducing depression. And that program was actually very effective for smoking cessation. And it was actually a vigorous exercise program. So really high intensity exercise.
Health Chatter
Tobacco Cessation
So that's one example, but yeah, there's a strong relationship. I worked with a mood researcher during my, when I was getting my doctoral degree. And so we looked at just the relationships between depression and smoking and it seems to be bi-directional where smoking can lead to depression and depression can lead to smoking.
Health Chatter
Tobacco Cessation
So that's interesting, but smokers compared to non-smokers generally report higher levels of depression, but also anxiety, stress. So that's why there's been a lot of research focusing on mood management programs. So in my lab, it was exercise, but other researchers are looking at how to manage your mood as a way to quit smoking, which is actually very effective as a behavioral program.
Health Chatter
Tobacco Cessation
I asked a question. I heard you mentioned a couple times the term safer. And, you know, you're talking about different things. And I'm wondering if safer is equivalent to being cooler when it comes to young people. You know, you hear this, okay, this is safer. Oh, so this is real cool because it's the latest trend. And I think, Bill, what do you think?
Health Chatter
Tobacco Cessation
I remember when I was a kid, when I was younger, those in our community that were cool really drank, they really smoked cools because it was cool and it was menthol. All those kinds of things. Our words being used to track younger people. Even today, I know that there's been a huge... there's been some efforts made in Minneapolis, in Minnesota about menthol cigarettes.
Health Chatter
Tobacco Cessation
Now, I'm excited about this because I knew of Dr. Patton, but I had never had the chance to meet her until very recently. And we had a chance to sit down and just kind of talk a little bit about, you know, work and talk a little bit about community, talk a little bit about ourselves.
Health Chatter
Tobacco Cessation
So I'm wondering if we're using words now to minimize the dangers of what's really going on because, yeah, I'll leave that there because dot, dot, dot, dot, dot.
Health Chatter
Tobacco Cessation
Yeah, that's an interesting observation. I think these new products probably are prestigious. Cool. I haven't heard that word as much as, well, this is, you know, or e-cigarettes, for example, this is safer than smoking, you know, almost to the point where this is safe.
Health Chatter
Tobacco Cessation
And so, you know, that's made me think a lot about how do you get through to kids about the harmful effects of some of these other products like pouches or e-cigarettes, because there's so much attention as we've been talking about, um, cigarette smoking and the harmful effect, but, um, Yeah, so I think that contributes to the normative use among youth too.
Health Chatter
Tobacco Cessation
But they probably perceive themselves as cool with the e-cigarettes and some of these other products. But I hear more of that word about safer. Like literally, I'm not doing damage to my body because I'm using these products. It's always compared to cigarette smoking. I don't know if anyone has heard.
Health Chatter
Tobacco Cessation
Yeah. I mean, the visual cues can definitely lead to craving for a cigarette. So it's, It's definitely true what you're saying about the importance of visual cues. Some of these products, like e-cigarette use, I remember with the vaping when my son was in high school, it was very easy to hide. They can put that in their pocket and take it out every now and then. So
Health Chatter
Tobacco Cessation
And so having this opportunity, when I found out that she was involved in tobacco research, I felt it was a great show for us to have here on Health Chatter. Now, I want to say a couple of things before I bring Dr. Patton on. Our research team came up with two different programs. themes are two different topics to lead off our research.
Health Chatter
Tobacco Cessation
Yeah, so I'm not sure how much the visual cues are impacting the use right now. But certainly when it's not in a setting where they're not prohibited from using, I could see that.
Health Chatter
Tobacco Cessation
I'm going to share a visual cue of mine. And I know I shouldn't confess this stuff, but we all chat and we confess a lot of stuff. Confess a lot of stuff.
Health Chatter
Tobacco Cessation
I try to be very sensitive to those that are homeless, and you see people on the street. But one thing that I will not do now is if I see somebody smoking a cigarette, I won't give them no money. And I think that that's just one of those visual cues for me is that, you know, hunger.
Health Chatter
Tobacco Cessation
And I know that many times, you know, my wife would tell me something like, well, you know, somebody could have given them the cigarette. I said, okay, you know, I'm not going to fight about that. But there's just something about that visual cue. And you don't have to put this in a recording if you don't want to.
Health Chatter
Tobacco Cessation
But it's something about that visual cue about smoking tobacco and being hungry that just, yeah. that causes me to ponder. I'll leave it alone, okay.
Health Chatter
Tobacco Cessation
Yeah, it's hard because nicotine is so addicting though, you know? Yeah. So I think, yeah, it's like if you see a homeless person drinking alcohol, you know, it's kind of that same potential feeling, but.
Health Chatter
Tobacco Cessation
Well, I think we, as before, we can think about reducing the prevalence of overall nicotine tobacco product use. So right now in the U S it's about one in five adults. Um, so we could think about a prevalence indicator, right? So maybe less than 10% for the next report or scorecard. But I also think about a major challenge that we have is that we have effective treatments, um,
Health Chatter
Tobacco Cessation
He says, after decades of research and proven tobacco control efforts, tobacco use has sealed the leading cause of preventable deaths and diseases in the U.S. And the second point that they made was that most tobacco products use begins in adolescence. Now, of course, that took me back because when I was younger, and I know I'm dating myself, but when I was younger, I remember the Marlboro Man.
Health Chatter
Tobacco Cessation
for tobacco cessation, but those are really greatly underutilized. So many, about half of people quit smoking every year, but only about 7% are successful. And these treatments that we have are very underutilized. Sometimes people don't know about them or sometimes they're unsure. Like what happens if I call the quit line? Who do I talk to? Do I have to be ready to quit that day?
Health Chatter
Tobacco Cessation
So there's all these, thoughts about treatments that people need education on. So I would think about to enhance the success of quit attempts to, so right now about a third of smokers utilize evidence-based treatment if they undergo a quit attempt. So I would think about at least half of the tobacco users using treatment as the next target.
Health Chatter
Tobacco Cessation
So that's something that I've been focused on in my research is how do we enhance the utilization of these effective treatments? And so there are free treatments available too. So.
Health Chatter
Tobacco Cessation
Okay. Dr. Penn, I'm sorry for interrupting you, but you did work in, you said you did work in Alaska around maternal child health.
Health Chatter
Tobacco Cessation
Can you talk a little bit more about that? One of the things that I think about is that when parents smoke around the child, what was some of your work around maternal child health and smoking? Did that deter families from smoking? Was that a deterrent?
Health Chatter
Tobacco Cessation
In general, with Pregnant women, there's some brief counseling that providers can do just to ask the woman about their tobacco use, ask about their readiness to quit, give them resources, follow up with them. So that can be helpful also and with the clinician talking about secondhand smoke exposure and the effects on children.
Health Chatter
Tobacco Cessation
So some of those interventions have been effective in pregnant women generally. In Alaska, we adapted that brief intervention to be culturally relevant with a lot of feedback from pregnant women. And we also had the intervention delivered by what we called native sisters or lay native elder women in the villages. And so that program was effective for tobacco abstinence postpartum.
Health Chatter
Tobacco Cessation
So that was encouraging. And we integrated our programs for pregnant women. We did our research within the existing healthcare system. So we didn't have a research building and did all this research and then get positive results and then try to figure out how do we implement this within their existing healthcare system. We actually did the research in the healthcare setting.
Health Chatter
Tobacco Cessation
So it's encouraging because now providers are using our materials. promoting the use of cessation services among pregnant women. The overall prevalence, however, has not reduced among pregnant women. So women in Alaska, Alaska native women, also, they not only smoke, they use a homemade form of smokeless tobacco called . So that's really ingrained in the community.
Health Chatter
Tobacco Cessation
Some women think it is safer to use because they're making the product themselves, and they burn a woody fungus that grows on the bark of birch trees in the area and use the ash to mix with tobacco leaves. So that's how it's made. But because the ash comes from a tree, it's perceived as safer. So again, kind of these perceptions of products being safer.
Health Chatter
Tobacco Cessation
So it is challenging in terms of kind of reducing the overall tobacco use prevalence. And right now, we have a program we're evaluating that is family-based, recognizing, and this was actually feedback from the pregnant women. One of the challenges because of the social norms is even if the woman would quit during pregnancy, a lot of people are using tobacco around her.
Health Chatter
Tobacco Cessation
He'd come in riding his horse, and he'd come smoking his cigarette. And I remember my father, he smoked pale milk, Paul Mall. I don't know what it was. But it was real strong tobacco. And I remember one time I took one from him and went down to the basement. And I started smoking that thing, and I got drunk and high as I could be. I don't know. Maybe that's why I don't do tobacco right now.
Health Chatter
Tobacco Cessation
So their spouse, family members. And so now we have a family-based program that we're evaluating at the request of pregnant women to focus more, not just on that woman, but those around her and really looking at the family system. So maybe if I come back in a couple of years, I can let you know how well that program worked. But what you bring up is really important.
Health Chatter
Tobacco Cessation
The family system and quitting tobacco. recognizing that it's just not individual determinants to behavior change. It's, it's really these social and environmental influences that we need to target.
Health Chatter
Tobacco Cessation
My friends, when I was going to school, they smoked cool. Everybody that was cool smoked cool. My other friends smoked Winston-Salem's. And TV was just filled with people smoking in the boardrooms, smoking down the street. So tobacco, you know, as Stan, as you just said a little bit earlier, we've been talking about this thing for a long, long time and it's still here.
Health Chatter
Tobacco Cessation
Well, I think with cigarette smoking, for example, the pandemic did not help.
Health Chatter
Tobacco Cessation
Yeah. So it was actually a growth in cigarette sales during that time. And then people are reporting more anxiety during the pandemic. So I'm kind of stuck. There were reports of people stockpiling cigarettes during that time. Wow. So. I think that didn't really, if there was any decrease in some of these vices, it didn't help with the pandemic.
Health Chatter
Tobacco Cessation
Yeah, I mean, people report turning to different things to alleviate stress, one being cigarettes, alcohol. And as I mentioned, I mean, we do know from research that cigarette smokers report more stress. So there is that documented association as well. But I was just thinking about the pandemic, how that really shook things up for people.
Health Chatter
Tobacco Cessation
So it'll be interesting to see what the new normal is going forward.
Health Chatter
Tobacco Cessation
I think going forward, what I found to be really meaningful work is the community engagement in Alaska to really listen to the voices of the community in terms of their needs and priorities. And that's helped us develop some programs, many effective, some not, but even with the not ones, the community has a voice in what's the next step, like the family-based intervention. So
Health Chatter
Tobacco Cessation
I think about that, although I'm focusing on indigenous communities primarily, I think about that with these other segments like youth and communities targeted more by the tobacco industry, communities with high tobacco prevalence. So I would encourage people, especially researchers, to think about community participatory research and how that might be helpful with the tobacco endgame.
Health Chatter
Tobacco Cessation
And then I just want to just say, I just want to ask Dr. Patton to start off with this is this, when did we find out how dangerous tobacco was?
Health Chatter
Tobacco Cessation
Great. Clarence, thoughts? Thank you, Dr. Patton, for accepting my invitation. I did learn a lot and look forward to working with you more on the See the Dream.
Health Chatter
Tobacco Cessation
There have been decades of research on that topic. I almost think about e-cigarettes and kind of a similar stage where we're not certain about the long-term health effects, let alone the short-term health effects. So due to research, we've been conducting studies since 1960s or so on the health effects of tobacco. And I think alongside with that study,
Health Chatter
Tobacco Cessation
the decrease in social norms around smoking as we learn more about the health effect. But the U.S. Surgeon General's report on the effects of tobacco, I think that was in the 70s. That was sort of a landmark report kind of spurring people's knowledge or awareness of the health effect.
Health Chatter
Tobacco Cessation
Right. Well, on a public health level, we have made many advancements with smoke-free policies, tobacco-free campaigns, going to mass media campaigns. So the overall prevalence from 1950s being in the high 40s to now 12% of the U.S. population, that is an advance, but yeah, still a long way to go. And also the tobacco industry aggressively markets certain subpopulations.
Health Chatter
Tobacco Cessation
So within certain communities like Alaska Native American Indian communities, for example, the prevalence remain high, but within those communities, the social norms around tobacco is still more towards acceptability. So, and that's a result of the tobacco industry marketing certain segments. So youth,
Health Chatter
Tobacco Cessation
So the overall prevalence is really affected by these sub communities that are more vulnerable to the tobacco industry. So the tobacco industry is a large force. They have a lot of money. They can make their cigarettes pretty cheaply. There's high demand. So.
Health Chatter
Tobacco Cessation
I think overall there's greater awareness of the health effects and the prevalence has gone down, which is encouraging, but you know, at the same time, other tobacco nicotine products have gained in popularity.
Health Chatter
Tobacco Cessation
Yeah, clearance. Yeah, no, I was going to say, it's always about the money in America, right? It's about making that money. But I think that one of the things that I want to go back, because I know that you do a lot of community-based participatory research. I want to go back to adolescence. I mean, the adolescence, use of tobacco.
Health Chatter
Tobacco Cessation
And can you talk about that and some of the research that maybe you've done with that? And I know that you have specifically dealt with specific communities. And I'd like to hear more about what are some of the struggles in terms of those areas as well.
Health Chatter
Tobacco Cessation
So among youth generally in the U.S. and in Minnesota, e-cigarette use is most common, followed by nicotine pouches and cigarettes. So with youth, it's difficult because with adults, there's effective treatments. So behavioral counseling, FDA approved medications for tobacco cessation. Whereas in youth, behavioral counseling, coaching is effective.
Health Chatter
Tobacco Cessation
But there is really, at this time, no evidence that nicotine patches, gum, and so on are effective for youth. So there's some limits to the treatment for youth cessation. So among adults and youth in the United States and Minnesota, Alaska Native American Indian communities do have higher rates of tobacco use. And that's the communities that I've been focusing on.
Health Chatter
Tobacco Cessation
And it's important to distinguish commercial tobacco use from traditional tobacco. tobacco use. So tobacco is part of the culture when used in a ceremonial, spiritual way among many Native American communities. So what we're really talking about is the commercial products or commercial use of tobacco as opposed to traditional use.
Health Chatter
Tobacco Cessation
So a lot of my research for many years has been in Alaska, the state of Alaska, working with Alaska Native and American Indian communities there. And I was invited by the tribal leadership to focus on this issue as a key priority for the communities. So with staff, other colleagues at the Nicotine Dependence Center at Mayo Clinic, we were invited just to explore this issue.
Health Chatter
Tobacco Cessation
And people did want to partner on this. It was really important to do research. So the community identified pregnant women and youth as the top kind of subgroups to focus on. So as far as you asked about youth, and we did evaluate a culturally adapted behavioral counseling intervention, because like I said, behavioral counseling for youth is effective.
Health Chatter
Tobacco Cessation
But we asked youth their preferences, you know, how do we culturally adapt this? What would you prefer in a program? And the youth said they wanted to be part of an intervention where they kind of were away from their village. There was 56 villages in the region I was working in and very rural Alaska.
Health Chatter
Tobacco Cessation
And basically it was a smoke-free event where we had kids stay for a weekend and there was behavioral counseling, but there was also talks by elders and other community members on the impact of tobacco. on their lives, but also kind of talking about what the future impacts could be.
Health Chatter
Tobacco Cessation
So it was very challenging though, for that program, it wasn't very effective in terms of long-term smoke smoking cessation, just because the kids then had to go back to their village where, as I mentioned, the social norms around tobacco use were such that, you know, there were many people including their parents using tobacco. So it was just really hard for them to quit. But overall,
Health Chatter
Tobacco Cessation
Any type of behavioral counseling program that's culturally aligned has been helpful for youth to quit. But as I said, even though youth are interested in medications, there's really not that evidence yet in youth to be able to offer that to them. So youth cessation is very challenging. There's still a lot of calls for research on that area.
Health Chatter
Tobacco Cessation
So let me ask you a question. Yes, Sam. Dr. Patton, in spite of all the research talking about how dangerous tobacco use is, is it expected to grow the use?
Health Chatter
Tobacco Cessation
I think at least remaining stable in terms of youth tobacco prevalence rates. I think with newer products being marketed, there's a high likelihood that use would increase. I think the tobacco industry is very adept at kind of finding new angles or new products like these nicotine pouches that have become more popular. The second most commonly used product among youth.
Health Chatter
Tobacco Cessation
You know, there are always these products like e-cigarettes are initially kind of word of mouth, tobacco marketing, maybe cigarettes.
Health Chatter
Tobacco Cessation
appealing to people because they're potentially safer to use because it's not a burn product or more of a combustible product like cigarettes but um nicotine pouches do contain nicotine e-cigarettes contain nicotine and you know these this can lead to nicotine addiction i don't know if you've ever known any i i i'm close to a family member um whose child used e-cigarettes and
Health Chatter
Tobacco Cessation
Just watching that individual come off e-cigarettes, the withdrawal symptoms, very similar to what I see in practice with cigarette smokers among adults or youth. The withdrawal symptoms can be pretty severe. And that nicotine addiction in youth does predict future use. So the earlier someone starts, the more likely that they will continue use. So it's really important to prevent youth onset of.
Health Chatter
Tobacco Cessation
Right. So the nicotine present in all of these products can lead to nicotine addiction. which can lead to withdrawal symptoms when quitting and so forth. And also the likelihood that someone will continue use due to that addiction. Tobacco products contain the tobacco leaf. And so in those products that is burned when using, so it's called combustible tobacco products.